| NPI | 1073278594 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE BENNETT Credentialing Supervisor 561-433-6009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2021-11-01 |